Preoperative Assessment and Patient Preparation
What the exam tests
Preoperative Assessment and Patient Preparation tests risk stratification, fasting, airway screening, consent, medication review, and readiness for anesthesia.
Core rules and concepts
- ASA physical status runs I–VI; add E for emergency. ASA class reflects systemic disease, not the surgical procedure alone.
- Standard fasting: clear fluids 2 h, breast milk 4 h, light meal 6 h, fatty or fried food 8 h. Clear fluids are encouraged in many patients until 2 h before induction.
- Screen the airway with Mallampati, mouth opening, thyromental distance, cervical mobility, dentition, beard, and prior difficulty.
- Review anticoagulants, insulin, SGLT2 inhibitors, beta-blockers, opioids, and obstructive sleep apnea. Check allergies, last meal, and consent.
- Premedication may target anxiety, aspiration risk, or a specific disease; it is ordered by the anesthesiologist.
Worked example
A 70-kg man with well-controlled hypertension and type 2 diabetes, no organ dysfunction, scheduled for elective hernia repair is ASA II. If he presents with acute appendicitis and is otherwise the same, he is ASA II E. If he had unstable angina or severe COPD with functional limitation, he would be ASA III.
Traps
Nothing-by-mouth after midnight is outdated and can cause dehydration; clear fluids are allowed up to 2 h. Do not ignore snoring, obesity, or a thick neck. Do not obtain anesthesia consent or promise a specific anesthetic; that is the anesthesiologist's responsibility. Do not accept a verbal fasting history without checking the record.